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Rock Hill Pediatrics Asthma Appropriate Care July 29, 2012. Background. June 2010 – all physicians and APPs polled to solicit feedback on metrics to be included in the Appropriate Care Measure Set for CHS Quality Goal setting

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Rock hill pediatrics asthma appropriate care july 29 2012

Rock Hill Pediatrics Asthma Appropriate Care July 29, 2012


Background
Background

  • June 2010 – all physicians and APPs polled to solicit feedback on metrics to be included in the Appropriate Care Measure Set for CHS Quality Goal setting

  • Mirrors the core measure sets that have been in place in acute care facilities

  • Four disease states were selected: Diabetes, Ischemic Vascular Disease, Heart Failure, and Asthma

  • Consistently listed as priority areas for quality reporting by CMS, Medicaid, National Quality Forum, and others

  • Nearly all metrics presented in the poll appear on national quality indicator lists

  • Beginning in 2011, process measures for four disease states were first tracked and reported system-wide




Asthma appropriate care
Asthma Appropriate Care

Metric

The percentage of patients who received appropriate ambulatory care for asthma, reported on a quarterly basis

Data Source

Abstraction of a random sample of patient charts from the five physician networks


Data sampling asthma
Data Sampling – Asthma

Inclusion Criteria

FM, IM, peds, and pulm patients with age ≥ 5 years at the time of the encounter and have one of the following diagnosis codes: 493.00, 493.01, 493.02, 493.10, 493.11, 493.12, 493.20, 493.21, 493.22, 493.81, 493.82, 493.90, 493.91, or 493.92

Base Population Querying

Patients meeting above criteria that received a disease diagnosis in IDX within the previous 18 mos. and seen in the previous 3 mos. for any reason are eligible for sampling

Sampling Methodology

Representative across practices

and volume of disease states seen,

using a modified JCAHO sample size

Exclusion Criteria

Patients diagnosed with reactive airway disease, bronchiolitis, or chronic bronchitis


Data collection
Data Collection

Methodology

  • Leveraged electronic information when available by pre-populating online data collection tool when possible

  • Information manually validated by auditor

  • 12,000+ charts abstracted each quarter during a 5-week time span


Appropriate care all or none measurement
Appropriate Care: All or None Measurement

Rationale

  • Measure of the care a patient should receive

  • Provides a system perspective that focuses on process

  • More sensitive scale for assessing improvements

  • Mirrors acute facility measure for Core Measures

    Success Factors

  • Small measure set for each disease

  • Improving processes for documentation

  • Adoption of Point of Care Reminders (Cerner EMR Health Maintenance Module)

Berwick and Nolan. 2006 American Medical Association


Small measure set
Small Measure Set

  • 3 metrics

    • Controller Medication for Persistent Symptoms

    • Assessment of Daytime/Nocturnal Symptoms

    • Influenza Vaccination

  • All or None concept


Improving processes for documentation
Improving Processes for Documentation

  • Physician Networks are composed of practices who are in various states of EMR migration (paper, hybrid, “fully” integrated)

  • Regardless of state, all have experienced challenges with addressing and documenting care measures

  • Flowsheets developed to assist paper-charting practices and prepare them for EMR implementation

  • Point of Care alerts released for EMR-charting practices








Rock hill pediatrics success factors
Rock Hill Pediatrics Success Factors

  • Narrow focus

    • 1 disease state, 3 measures

  • Physician Champion

  • Practice Manager support

  • Standard Processes

  • Practice-based Quality Improvement

  • Culture supportive of continual learning and progress

  • COMPETITIVE!


Maintenance of certification asthma appropriate care
Maintenance of Certification – Asthma Appropriate Care

  • Practice-wide improvement effort lends itself to Part IV MOC - Physician Participation in a QI Project

  • Attestations in progress for 8 physicians!


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